Decision support or support for situated choice: Lessons for system design from effective manual systems

In a number of organisational settings where work is highly skilled but substantially routine, certain entrenched manual systems have resisted digitisation. These systems include card-based systems in emergency despatch, the paper flight progress strips system used in air traffic control, the Kanban system and whiteboard systems used in hospital wards. Research to understand or replace these systems has frequently regarded them as decision support systems (DSS). We report here a detailed case study of a manual whiteboard-based bed allocation system in the ICU of a large general hospital, which shows that the support it provides for users action choices cannot be validly conceived as decision support. This system and other effective manual systems may be better understood as a situated choice support system (SCSS). Whereas DSS provide actors with a model of the action environment in order to support reasoning about the consequences of alternative actions, SCSS provide actors with structured work environments that reduce possible actions and cue-providing information resources to support a reactive choice between these limited alternatives. The findings warn of the danger of uncritically applying the DSS design paradigm to supporting action choice in skilled routine work, and provide an alternative design theory, which can potentially inform new ICT-based designs.